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Cannabis and Cannabinoid Research Jun 2022Cannabinoid hyperemesis syndrome (CHS) is a diagnosis of exclusion with intractable nausea, cyclic vomiting, abdominal pain, and hot bathing behavior associated with...
Cannabinoid hyperemesis syndrome (CHS) is a diagnosis of exclusion with intractable nausea, cyclic vomiting, abdominal pain, and hot bathing behavior associated with ongoing tetrahydrocannabinol (THC) exposure. Increasing cannabis use may elevate CHS prevalence, exacerbating a public health issue with attendant costs and morbidity. This study, the largest contemporaneous database, investigated genetic mutations underlying CHS. Patients with CHS diagnosis and ongoing symptoms were compared with current cannabis users lacking symptoms. A screening questionnaire was posted online. Of 585 respondents, 205 qualified as the CHS pool and 54 as controls; a reduced pool of 28 patients and 12 controls ultimately completed genomic testing. Patients and controls were high-frequency users of cannabis flower or concentrates (93%), using multiple grams/day of THC-predominant material. Among patients, 15.6% carried diagnoses of cannabis dependency or addiction, and 56.6% experienced withdrawal symptoms. About 87.7% of patients improved after cannabis cessation, most suffering recurrence rapidly after resumption. Findings in patients included mutations in genes {odds ratio, 12 (95% confidence limit [CL], 1.3-88.1) =0.012}, transient receptor potential vanilloid receptor 1 () (odds ratio, 5.8 [95% CL, 1.2-28.4] =0.015), (odds ratio, 7.8 [95% CL, 1.1-70.1] =0.043), gene coding dopamine-2 receptor () (odds ratio, 6.2 [95% CL, 1.1-34.7] =0.031), and ATP-binding cassette transporter gene () (odds ratio, 8.4 [95% CL, 1.5-48.1] =0.012). Some participants were reluctant to undergo genetic testing; only 28 of 99 CHS patients who agreed to testing ultimately returned a kit. This is the largest patient cohort of CHS examined to date, and first to note associated mutations in genes affecting neurotransmitters, the endocannabinoid system, and the cytochrome P450 complex associated with cannabinoid metabolism. Although the sample size was smaller than desired, these preliminary findings may contribute to the growing body of knowledge, stimulate additional investigation, help elucidate the pathophysiology of CHS, and, ultimately, direct future treatment.
Topics: Cannabinoid Receptor Agonists; Cannabinoids; Cannabis; Dronabinol; Female; Genomics; Hallucinogens; Humans; Hyperemesis Gravidarum; Pregnancy; Surveys and Questionnaires
PubMed: 34227878
DOI: 10.1089/can.2021.0046 -
Public Health Nutrition Mar 2022Adequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in...
OBJECTIVE
Adequate dietary intake during pregnancy is vital for the health and nutritional status of both mother and fetus. The nutritional status of reproductive age women in Pakistan is poor, with 14 % being underweight (BMI < 18·5) and 42 % experiencing Fe deficiency anaemia. This may stem from beliefs, practices and other barriers influencing dietary intake. This qualitative study seeks to determine which factors impact dietary intake during pregnancy in rural Punjab.
DESIGN
In-depth interviews and focus group discussions were conducted and then analysed using thematic analysis.
SETTING
Three purposively selected rural districts (Sahiwal, Okara and Pakpatan) with the highest prevalence of maternal and child malnutrition in the province of Punjab, Pakistan.
PARTICIPANTS
Mothers with children under age two (n 29) and healthcare providers with at least 5 years of experience working in the district (n 12).
RESULTS
We identified a combination of physiological, socio-cultural and structural barriers that inhibited healthful dietary intake during pregnancy. The primary physiological barriers to optimal dietary intake and dietary practices included food aversions and food cravings. Food classification, fear of a difficult childbirth, fear of high blood pressure and household food politics were the principal socio-cultural barriers. Additionally, two structural barriers, inadequate antenatal counseling and a lack of affordable food options, were identified.
CONCLUSIONS
Our study demonstrates that complex barriers prevent pregnant women in the Punjab area from consuming adequate dietary intake and that antenatal health education programmes and structural interventions are needed to support healthful dietary practices during this critical period.
Topics: Child; Child, Preschool; Diet; Female; Humans; Nutritional Status; Pakistan; Pregnancy; Pregnant Women; Rural Population
PubMed: 33866982
DOI: 10.1017/S1368980021001737 -
BMJ Open Sep 2019Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns...
OBJECTIVE
Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, detailed knowledge about SA/DP patterns around childbirth is lacking. We aimed to compare SA/DP across different time periods among women according to their childbirth status.
DESIGN
Register-based longitudinal cohort study.
SETTING
Sweden.
PARTICIPANTS
Three population-based cohorts of nulliparous women aged 18-39 years, living in Sweden 31 December 1994, 1999 or 2004 (nearly 500 000/cohort).
PRIMARY AND SECONDARY OUTCOME MEASURES
Sum of SA >14 and DP net days/year.
METHODS
We compared crude and standardised mean SA and DP days/year during the 3 years preceding and the 3 years after first childbirth date (Y to Y), among women having (1) their first and only birth during the subsequent 3 years (B1), (2) their first birth and at least another delivery (B1+), and (3) no childbirths during follow-up (B0).
RESULTS
Despite an increase in SA in the year preceding the first childbirth, women in the B1 group, and especially in B1+, tended to have fewer SA/DP days throughout the years than women in the B0 group. For cohort 2005, the mean SA/DP days/year (95% CIs) in the B0, B1 and B1+ groups were for Y: 25.3 (24.9-25.7), 14.5 (13.6-15.5) and 8.5 (7.9-9.2); Y: 27.5 (27.1-27.9), 16.6 (15.5-17.6) and 9.6 (8.9-10.4); Y: 29.2 (28.8-29.6), 31.4 (30.2-32.6) and 22.0 (21.2-22.9); Y: 30.2 (29.8-30.7), 11.2 (10.4-12.1) and 5.5 (5.0-6.1); Y: 31.7 (31.3-32.1), 15.3 (14.2-16.3) and 10.9 (10.3-11.6); Y: 32.3 (31.9-32.7), 18.1 (17.0-19.3) and 12.4 (11.7-13.0), respectively. These patterns were the same in all three cohorts.
CONCLUSIONS
Women with more than one childbirth had fewer SA/DP days/year compared with women with one childbirth or with no births. Women who did not give birth had markedly more DP days than those giving birth, suggesting a health selection into childbirth.
Topics: Adult; Birth Order; Cohort Studies; Female; Humans; Longitudinal Studies; Morning Sickness; Parturition; Pensions; Pregnancy; Prenatal Care; Registries; Sick Leave; Sweden
PubMed: 31501131
DOI: 10.1136/bmjopen-2019-031593 -
Tidsskrift For Den Norske Laegeforening... Jan 2023Primary adrenal insufficiency is relatively common in children, but primary presentation with acute shock/adrenal crisis is rare. Congenital adrenal hyperplasia (CAH) is...
BACKGROUND
Primary adrenal insufficiency is relatively common in children, but primary presentation with acute shock/adrenal crisis is rare. Congenital adrenal hyperplasia (CAH) is the most common cause in children and is part of the newborn diagnostic screening programme in Norway.
CASE PRESENTATION
We admitted a schoolgirl with a history of nausea and morning sickness for the previous three weeks. Shortly after admission she was somnolent, tachycardic (148 beats per minute) and pale. After initial administration of a 500 ml bolus of Ringers acetate she was transmitted to the ICU. She responded poorly on IV fluids and epinephrine alone. Arterial blood gas test showed metabolic acidosis with hyponatraemia 122 mmol/L, hyperkalaemia 5,6 mmol/L and hypoglycaemia 2,2 mmol/L, and adrenal insufficiency was suspected. She responded well to treatment with hydrocortisone and was transferred to a university hospital for further examination and diagnosis.
INTERPRETATION
Acute adrenal crisis is a rare primary presentation of adrenal insufficiency, especially in the paediatric population. It is an important differential diagnosis of shock and has high morbidity and mortality.
Topics: Child; Female; Humans; Acute Disease; Adrenal Hyperplasia, Congenital; Adrenal Insufficiency; Hydrocortisone; Hyponatremia; Shock
PubMed: 36718904
DOI: 10.4045/tidsskr.22.0354 -
Nutrients Nov 2020Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to... (Review)
Review
Polyunsaturated fatty acids (PUFAs) have been studied in relation to pregnancy. However, there is limited knowledge on PUFAs and their metabolites in relation to hyperemesis gravidarum (HG), a pregnancy complication associated with nutritional deficiencies and excessive vomiting. In order to survey the field, a systematic review of the literature was performed, which also included nausea and vomiting of pregnancy (NVP) due to its close relationship with HG. In the very few published studies found, the main subjects of the research concerned free fatty acids (four records), lipid profiles (three records), and bioactive lipids (one article about prostaglandin E and one about endocannabinoids). The authors of these studies concluded that, although no cause-and-effect relationship can be established, HG is linked to increased sympathetic responsiveness, thermogenic activity and metabolic rate. In addition, NVP is linked to a metabolic perturbance (which lasts throughout pregnancy). The low number of retrieved records underlines the need for more research in the area of PUFAs and HG, especially with regard to the underlying mechanism for the detected effects, potentially involving growth differentiation factor 15 (GDF15) since evidence for GDF15 regulation of lipid metabolism and the role for GDF15 and its receptor in nausea and vomiting is emerging.
Topics: Databases as Topic; Fatty Acids, Unsaturated; Female; Humans; Hyperemesis Gravidarum; Metabolome; Pregnancy
PubMed: 33158081
DOI: 10.3390/nu12113384 -
Annals of Palliative Medicine Mar 2021The magnitude of the incidence and impact of nausea on patients receiving intravenous chemotherapy seems to be underestimated by healthcare professionals. Development of... (Observational Study)
Observational Study
BACKGROUND
The magnitude of the incidence and impact of nausea on patients receiving intravenous chemotherapy seems to be underestimated by healthcare professionals. Development of effective anti-emetic treatment has contributed to the resolution of chemotherapy-induced nausea and vomiting (CINV). However, there is a concern that vomiting has been the initial focus of anti-emetic research and nausea was perceived as a secondary endpoint. Through focusing on the incidence of nausea independently of the incidence of vomiting, valuable information has been gained on this distressing side effect, including identifying patient risk factors contributing to the increased experience of nausea.
METHODS
The study followed a prospective, observational study design in a private oncology centre in Johannesburg, South-Africa. Ethical approval was obtained before commencement of the study, followed by the recruitment of one hundred patients over a seven-month period. Patient-reported outcome measures (PROMs) were used to measure nausea with an amended version of the Multinational Association of Supportive Care in Cancer antiemesis tool (MAT). Patients documented information in their diaries on the incidence, duration and severity of nausea, during the acute phase (0-24 hours), the delayed phase (25-120 hours), day 7 and day 10 after infusion of chemotherapy, with episodes of vomiting being recorded as a secondary endpoint. The demographic and clinical variables of the subjects, as well as patient risk factors known to cause CINV, were tabulated and summarised using descriptive statistics.
RESULTS
The population consisted of 68 females and 27 males with a mean age of 57 years (25-84 years). The emetogenicity of chemotherapy regimens administered were well represented with 26.3% low emetogenic chemotherapy, 25.3% moderately emetogenic chemotherapy and 48.4% highly emetogenic chemotherapy (HEC). Despite all patients receiving guideline consistent CINV prophylaxis, nausea was still experienced by 57.9% patients during cycle one, 50.6% patients during cycle two and 45.6% patients during cycle three. The incidence of patients experiencing nausea (in the absence of vomiting) was 35%, compared to 2% of patients experiencing vomiting (in the absence of nausea). Patient characteristics with a known risk to impact CINV were documented, and significant impact in this study was found in female gender, age <60 years, history of motion sickness and history of morning sickness.
CONCLUSIONS
Guideline consistent CINV prophylaxes seem to have vomiting under control for most patients receiving intravenous chemotherapy. Nausea, however, still seems to be a persistent adverse event during treatment. Female gender, age <60 years, history of motion sickness and history of morning sickness increases the risk of experiencing nausea. A different approach is needed to manage nausea in the clinic setting, along with standardised tools to measure nausea specifically. More studies need to be done with nausea as the primary endpoint to address this ongoing medical need.
Topics: Antiemetics; Antineoplastic Agents; Female; Humans; Incidence; Male; Middle Aged; Nausea; Neoplasms; Prospective Studies; South Africa; Vomiting
PubMed: 33549001
DOI: 10.21037/apm-19-453 -
Obstetrics and Gynecology May 2016The American College of Obstetricians and Gynecologists recommends early treatment of nausea and vomiting of pregnancy to stop progression to hyperemesis gravidarum....
The American College of Obstetricians and Gynecologists recommends early treatment of nausea and vomiting of pregnancy to stop progression to hyperemesis gravidarum. Nausea and vomiting and hyperemesis gravidarum typically occur during the first trimester, the sensitive time for exposure to teratogens because organogenesis is occurring in the embryo. An efficacious treatment used widely across the United States for both nausea and vomiting of pregnancy and hyperemesis gravidarum is ondansetron. Recent studies have provided conflicting findings on the safety of ondansetron during pregnancy. There are numerous limitations in the current literature on ondansetron safety including exposure to the medication is not limited to sensitive windows of organogenesis, there is a lack of information on dosing and compliance, self-reports of exposure are commonly used, an inadequate accounting exists for other factors that may explain the relationship between ondansetron exposure and the adverse outcome, and there exists a lack of biologic plausibility by which ondansetron might cause harm. It is the authors' opinion that current data do not support a reluctance to treat women with ondansetron in clinical practice.
Topics: Antiemetics; Female; Humans; Hyperemesis Gravidarum; Ondansetron; Pregnancy; Prenatal Care
PubMed: 27054931
DOI: 10.1097/AOG.0000000000001375 -
PloS One 2023To assess the prevalence of acute mountain sickness (AMS) in 1370 mountaineers at four different altitudes in the Western Alps. We also examined the influence of... (Observational Study)
Observational Study
OBJECTIVE
To assess the prevalence of acute mountain sickness (AMS) in 1370 mountaineers at four different altitudes in the Western Alps. We also examined the influence of potential risk factors and the knowledge about AMS on its prevalence.
METHODS
In this observational cross-sectional study AMS was assessed on the day of ascent by the Lake Louise score (LLS, cut-off ≥3, version 2018) and the AMS-Cerebral (AMS-C) score of the environmental symptom questionnaire (cut-off ≥0,70). The latter was also obtained in the next morning. Knowledge regarding AMS and high-altitude cerebral edema (HACE) and the potential risk factors for AMS were evaluated by questionnaires.
RESULTS
On the day of ascent, the prevalence of AMS assessed by the LLS and AMS-C score was 5.8 and 3.9% at 2850 m, 2.1 and 3.1% at 3050 m, 14.8 and 10.1% at 3650 m, and 21.9 and 15% at 4559 m, respectively. The AMS prevalence increased overnight from 10.1 to 14.5% and from 15 to 25.2% at 3650 m and 4559 m, respectively, and was unchanged at 2850 m and 3050 m. A history of AMS, higher altitude, lower degree of pre-acclimatization, and younger age were identified as risk factors for developing AMS. Slow ascent was weakly associated with AMS prevalence, and sex and knowledge about AMS and HACE were indistinct.
CONCLUSION
AMS is common at altitudes ≥ 3650 m and better knowledge about AMS and HACE was not associated with less AMS in mountaineers with on average little knowledge.
Topics: Humans; Altitude Sickness; Prevalence; Acute Disease; Risk Factors; Altitude
PubMed: 37708123
DOI: 10.1371/journal.pone.0291060 -
Acta Obstetricia Et Gynecologica... Aug 2021Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be...
INTRODUCTION
Little is known about the pathophysiology of hyperemesis gravidarum (HG). Proposed underlying causes are multifactorial and thyroid function is hypothesized to be causally involved. In this study, we aimed to assess the utility of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) as a marker and predictor for the severity and clinical course of HG.
MATERIAL AND METHODS
We conducted a prospective cohort study including women admitted for HG between 5 and 20 weeks of gestation in 19 hospitals in the Netherlands. Women with a medical history of thyroid disease were excluded. TSH and FT4 were measured at study entry. To adjust for gestational age, we calculated TSH multiples of the median (MoM). We assessed HG severity at study entry as severity of nausea and vomiting (by the Pregnancy Unique Quantification of Emesis and nausea score), weight change compared with prepregnancy weight, and quality of life. We assessed the clinical course of HG as severity of nausea and vomiting and quality of life 1 week after inclusion, duration of hospital admissions, and readmissions. We performed multivariable regression analysis with absolute TSH, TSH MoMs, and FT4.
RESULTS
Between 2013 and 2016, 215 women participated in the cohort. TSH, TSH MoM, and FT4 were available for, respectively, 150, 126, and 106 of these women. Multivariable linear regression analysis showed that lower TSH MoM was significantly associated with increased weight loss or lower weight gain at study entry (ΔKg; β = 2.00, 95% CI 0.47-3.53), whereas absolute TSH and FT4 were not. Lower TSH, not lower TSH MoM or FT4, was significantly associated with lower nausea and vomiting scores 1 week after inclusion (β = 1.74, 95% CI 0.36-3.11). TSH and FT4 showed no association with any of the other markers of the severity or clinical course of HG. Twenty-one out of 215 (9.8%) women had gestational transient thyrotoxicosis. Women with gestational transient thyrotoxicosis had a lower quality of life 1 week after inclusion than women with no gestational transient thyrotoxicosis (p = 0.03).
CONCLUSIONS
Our findings show an inconsistent role for TSH, TSH MoM, or FT4 at time of admission and provide little guidance on the severity and clinical course of HG.
Topics: Adult; Biomarkers; Cohort Studies; Female; Humans; Hyperemesis Gravidarum; Predictive Value of Tests; Pregnancy; Prenatal Diagnosis; Prospective Studies; Severity of Illness Index; Thyrotropin; Thyroxine
PubMed: 33606270
DOI: 10.1111/aogs.14131 -
Advances in Drug and Alcohol Research 2023Public perception surrounding whether cannabis use is harmful during pregnancy often diverges greatly from the recommendations of doctors and healthcare providers. In... (Review)
Review
Public perception surrounding whether cannabis use is harmful during pregnancy often diverges greatly from the recommendations of doctors and healthcare providers. In contrast to the medical guidance of abstinence before, during, and after pregnancy, many women of reproductive age believe cannabis use during pregnancy is associated with little potential harm. Legalization and social cues support public perceptions that cannabis use during pregnancy is safe. Moreover, pregnant women may consider cannabis to be a safe alternative for treating pregnancy related ailments, including morning sickness. Compounding the problem is a lack of medical and federal guidance on safe, low, or high-risk levels of cannabis use. These issues mirror the continuing debate surrounding alcohol use and health, in particular, whether there are safe or lower risk levels of alcohol consumption during pregnancy. Clinical studies to date suffer from several limitations. First, most human studies are correlative in nature, meaning that causal associations cannot be made between cannabis exposure and health and behavioral outcomes later in life. Due to obvious ethical constraints, it is not possible to randomly assign pregnant mothers to cannabis or other drug exposure conditions-a requirement needed to establish causality. In addition, clinical studies often lack quantitative information on maternal exposure (i.e., dose, frequency, and duration), include a small number of individuals, lack replication of outcome measures across cohorts, rely on self-report to establish maternal drug use, and suffer from unmeasured or residual confounding factors. Causal associations between maternal cannabis exposure and offspring outcomes are possible in preclinical cohorts but there is a large amount of heterogeneity across study designs and developmental differences between rodents and humans may limit translatability. In this review, we summarize research from human and preclinical models to provide insight into potential risks associated with prenatal cannabinoid exposure (PCE). Finally, we highlight gaps in knowledge likely to contribute to the growing divide between medical guidance and public attitudes regarding cannabis use during pregnancy.
PubMed: 38389825
DOI: 10.3389/adar.2023.10981